Irita et al.

Discover Public Health (2025) 22:376 Discover Public Health

[Link]

RESEARCH Open Access

Recrudescence of measles cases in children

under 5 years of age and associated factors
in the health district of Logbaba, Cameroon: an
unpaired case-control study
Florence Irita1, Godfroy Rostant Pokam Djoko2*, Kelly Cynthia Fodom Tchogang3, Joseph Raphael Moyo Tachoum4,
Annick Suzanne Mbazoa Mbou1, Paule Dorcas Ngankeu Tooua2, Gwladys Kamwa Tchiemou1, Vanel Dongpe Zanbou4
and Monique Amor Yossa1

*Correspondence:
Godfroy Rostant Pokam Djoko Abstract
godfroydjoko@[Link]
1
Department of Public Health, Introduction : Measles, which is highly contagious and vaccine-preventable, is a
School of Health Sciences of the major public health problem considered to be one of the main causes of morbidity
Catholic University of Central Africa, and mortality in developing countries such as Cameroon. This study aimed to assess
Yaoundé, Cameroon
2
Research Unit of Applied Biology the factors associated with the recrudescence of measles cases in the Logbaba health
and Ecology, Department of district in Cameroon.
Animal Biology, Faculty of Science,
University of Dschang, Dschang, Methodology : To carry out this work, we used an analytical case-control study in
Cameroon which data were collected at the community level using a questionnaire administered
3
Research Unit Physiology and to parents of children under 5 years of age (n = 306) residing in the district. Factors were
Pharmacology, Department of
Animal Biology, Faculty of Science, established by determining relative and absolute frequencies, and associations were
University of Dschang, Dschang, estimated by calculating Odds ratios, confidence intervals, and p-values.
Cameroon
4
Research Unit in Biochemistry of Results The results showed that being less than 1 year old [AOR = 2.36 (95% CI 0.3–15);
Medicinal Plants, Food Science p = 0.027], living in a household of 1 to 3 people [AOR = 7.28 (95% CI 1.12–71.44);
and Nutrition, Department of p = 0.001], having unemployed parents [AOR = 24.66 (95% CI 3.13–278); p = 0.030],
Biochemistry, Faculty of Science,
University of Dschang, Dschang, and not having been vaccinated against measles [AOR = 15.55 (95% CI 1.6–69);
Cameroon p = 0.037] were significantly associated with an upsurge in measles cases. In addition,
non-compliance with the vaccination schedule [AOR = 13.49 (95% CI 1.44–38.82);
p < 0.0001], lack of vitamin A supplementation [AOR = 8.18 (95% CI 1.27-38); p = 0.002],
attendance at establishments without hand-washing facilities [AOR = 13.4 (95% CI
1.57–25.7); p = 0.017], undernutrition [AOR = 4.02 (95% CI 0.34–11.3); p = 0.0006], and
previous contact with a measles patient [AOR = 9.08 (95% CI 1.44–53.3); p < 0.0001] also
proved to be major predictors of the recrudescence of measles cases in the Logbaba
health district.
Conclusions This study highlights the factors associated with the recrudescence
of measles cases in the Logbaba health district, including children’s age, parent’s
employment status, and non-compliance with the immunization schedule. The
results underline the importance of targeted interventions, such as raising awareness

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Irita et al. Discover Public Health (2025) 22:376 Page 2 of 14

of vaccination, improving access to nutrition and hygiene, and community-based

prevention programs. By understanding these factors, it will be possible to optimize
the allocation of public health resources, thereby strengthening efforts to eliminate
measles and protect vulnerable populations.
Keywords Measles, Associated factors, Recrudescence, Children under 5, Cameroon

1 Introduction
Measles is an acute, highly contagious viral disease caused by a virus of the Paramyxo-
viridae family, which is transmitted by direct contact or through the air. It is a human
disease that mainly affects children (aged between 6 months and 14 years), and adult
cases are possible [1]. In 1980, before the widespread introduction of vaccination, an
estimated 2.6 million deaths a year were due to measles [1]. Measles vaccination pre-
vented 56 million deaths between 2000 and 2021 [2]. This infectious disease is highly
contagious, with an average incubation period of 14 days, ranging from 7 to 21 days. An
infected person is contagious 4 days before and 4 days after the appearance of the rash
[3].
Prodromal symptoms include fever, conjunctivitis, coryza, cough, and red spots with
a white center on the oral mucosa [3]. The basic reproduction rate (R0) of measles is
often estimated at between 12 and 18, meaning that an infected person can transmit the
virus to 12 to 18 non-immune individuals in a totally susceptible population [4]. This
underlines the importance of vaccination in establishing herd immunity and protecting
vulnerable individuals [1]. The frequency of complications varies from region to region:
in industrialized countries, 10–15% of cases present complications, while in developing
countries this figure can be as high as 75% [2]. The most common complications include
pneumonia, encephalitis, and severe diarrhea, which can have serious health conse-
quences [3].
Measles vaccination prevented 56 million deaths between 2000 and 2021 [2]. The
average incubation period for measles is 14 days, ranging from 7 to 21 days. A person
infected with measles is contagious 4 days before and 4 days after the appearance of the
rash [3]. People infected with measles often present with prodromal fever, conjunctivi-
tis, coryza, cough, and the presence of reddish patches with a white center on the oral
mucosa. The frequency of complications varies throughout the world. In industrialized
countries, complications occur in around 10–15% of cases, whereas in developing coun-
tries, up to 75% of cases may have one or more complications [1].
Worldwide, according to the World Health Organization and the U.S. Centers for Dis-
ease Control and Prevention, there will be 10.3 million cases of measles and 107,500
deaths in 2023, mainly in children under 5, with an increase of 20% compared with 2022
[1, 5]. In Africa, 1,759,000 cases of measles and 52,600 deaths have been recorded since
the start of the epidemic in 2018, and the disease is one of the ten leading causes of child
mortality [2]. In Cameroon, 6,054 cases of measles have been recorded, with 31 deaths
in 2023 [2, 6]. Health authorities have reported an increase in measles cases, with more
than 3,700 suspected cases, including 1,387 confirmed cases in several regions between
1 January and 3 July 2022. This is almost triple the 1,429 cases reported over a similar
period in 2021. These annual variations in cases can be attributed to a number of factors,
including the disruption to vaccination services during the COVID-19 pandemic, as well
as changes in surveillance systems that may have affected case detection and reporting.
Irita et al. Discover Public Health (2025) 22:376 Page 3 of 14

In Cameroon, the epidemiology of measles has shown a worrying trend over the last
five years. In 2019, the country recorded 2,809 cases of measles with 38 deaths, followed
by 1,509 cases and 25 deaths in 2020. In 2021, the number of cases fell considerably to
771, with 19 deaths, before rising again to 3,217 cases and 20 deaths in 2022. In 2023,
a further increase was observed, with 6,054 cases and 31 deaths [2, 6]. In the Logbaba
health district, 130 confirmed cases of measles have been reported, with 2 deaths, result-
ing in an estimated case-fatality rate of 1.5% [7]. This represents an alarming increase in
the 13 cases recorded in 2021 and the 25 cases in 2022, indicating a worrying trend in
the transmission of this disease.
Consequently, the increase in measles cases is likely to contribute to a significant rise
in infant mortality, exacerbating early school leaving among young children and worsen-
ing poverty conditions in developing countries [8, 9]. In addition, in populations suf-
fering from malnutrition, particularly where there is vitamin A deficiency and limited
access to adequate healthcare, it is estimated that 3–6% of measles cases can result in
death [10]. In displaced groups, this rate can be as high as 30%. In the Logbaba health
district, measles is closely linked to other health problems, notably malnutrition and
limited access to healthcare. Malnutrition, particularly prevalent among children under
five, weakens the immune system, making them more susceptible to developing serious
measles-related complications. At the same time, limited access to health services in this
region not only delays the diagnosis and treatment of measles cases but also limits vac-
cination coverage.
Thus, these data constitute an urgent call to action, drawing renewed attention to the
importance of limiting this spread. With this in mind, the present study aims to inves-
tigate the factors associated with the recrudescence of measles cases in the Logbaba
health district in order to provide evidence that can guide public health strategies. The
interest of this study lies in its potential to contribute to the optimization of vaccination
interventions and community awareness-raising, with a view to reducing the morbid-
ity and mortality associated with measles, particularly in a context where this disease
remains a significant threat to vulnerable children. By shedding light on local issues, this
study can also serve as a basis for targeted initiatives aimed at improving the health of
populations in at-risk areas.

2 Materials and methods

2.1 Study framework and period
This study was carried out over a period of 9 months, from March 2024 to November
2024, including preparation, analysis, and writing activities, while data collection was
concentrated over a period of 3 months, from August to October 2024. It took place in
the Logbaba health district, more specifically in the health areas of Nkongui, NdogpassiI,
NdogpassiII, Logbaba center, Logbaba plateau, Ndogsimbi, Ndogbati, Mboppi, Ndokoti
and Saint Michel. This district, which will have a population of around 279,923 in 2023,
is located in the Wouri department, specifically in the Douala 3rd arrondissement. It is
bordered to the west by the Deido and New-Bell districts, to the north by the Cité des
Palmiers district, to the south by the Nylon district, and to the east by the Japoma health
district. The district has 46 recognized health facilities, including public, religious, and
private facilities. It is a semi-urban, semi-rural district. This site was chosen for the fol-
lowing reasons: the Logbaba health district recorded a recrudescence of measles cases
Irita et al. Discover Public Health (2025) 22:376 Page 4 of 14

(130 cases) in 2023; moreover, it is a densely populated area (279,923 inhabitants) which
may lead to greater transmission of the virus [7].

2.2 Study design and study population

The study conducted was a case-control study with non-probabilistic convenience sam-
pling among children under 5 years of age living in the Logbaba health district. In this
study, cases were defined as all children under 5 years of age with a positive measles
status, confirmed by a clinical diagnosis, residing in the district for at least one year, and
whose parents or guardians had given their consent to the study. Controls were children
under 5 years of age with measles-negative status, living in the same district, and whose
parents or guardians had consented to the study. On the other hand, all children whose
parents or guardians had not given their consent, those aged 0 to 5, and those who had
left the locality during the collection period were excluded.
To ensure comparability between cases and controls, the latter were selected from the
same healthcare facilities and epidemiological surveillance data. This approach ensured
that both groups came from a similar environment, reducing potential bias in the selec-
tion of participants. Children under 6 months of age, who are not eligible for measles
vaccination, were excluded from the study, as were those who had left the locality during
the data collection period.

2.3 Sample size and procedure

The minimum sample size was set at 306 participants, comprising 102 cases and 204
controls, using StatCalc software from Epi Info 7. Precision was set at 5%, with a con-
fidence interval (CI) of 95%, and study power was set at 80%. The case-control ratio
was set at 2, and the percentage of unvaccinated controls was estimated at 32.21% [7],
while the percentage of unvaccinated cases was 48.7%, with an Odds ratio of 2. The sam-
pling technique used for this study was non-probability convenience sampling, with an
unpaired sample.

2.4 Data collection techniques and tools

Data were collected by means of a household survey using a structured questionnaire.
The questionnaire included sections on participants’ socio-demographic characteristics,
vaccination status, and questions on environmental and behavioral factors associated
with measles. Each section was designed to gather precise and relevant information in
order to analyze the risk factors associated with the recrudescence of cases.
For anthropometric measurements, we used a tape measure, a measuring cup, and a
weighing scale, following standard operating procedures to ensure the accuracy of the
data. Body mass index (BMI) was calculated using the following formula: BMI = weight
(kg) / height (m²). Weight and height measurements were taken with care, ensuring that
participants were in the correct position to obtain reliable results. BMI was chosen as
the anthropometric measure in this study because of its simplicity and ease of use in
a community setting. Although it is recognized that weight-for-height and weight-for-
height (WH) Z-scores are more appropriate indicators for assessing children’s nutri-
tional status, this decision allowed for more rapid and accessible data collection, while
recognizing the limitations of BMI in accurately assessing child nutrition.
Irita et al. Discover Public Health (2025) 22:376 Page 5 of 14

A pre-test of the questionnaire was carried out on 10 households in a neighboring dis-

trict to assess the clarity of the questions and the effectiveness of the collection method.
This pre-test enabled any necessary adjustments to be made to the questionnaire before
it was deployed in the Logbaba health district, thereby ensuring the quality and rele-
vance of the data collected.

2.5 Definition and operationalization of variables

This study identified one dependent variable and several independent variables. The
dependent variable for this study was defined as ‘measles status’. It is a categorical nomi-
nal variable with two case/control modalities, where ‘case’ was ticked for a child with a
positive measles status recorded during the year 2023 and ‘control’ in the opposite case.

2.6 Data collection procedure

After obtaining the approval of the scientific research committee of the School of Health
Sciences of the Catholic University of Central Africa and that of the Littoral Regional
Delegate for Public Health, we met with the Head of the Logbaba health district to obtain
authorization for the survey. Once in the district, we presented ourselves to the epide-
miological surveillance focal point, which gave us access to the various cases of measles
recorded in the district via the community health workers involved in surveillance.
Data were collected in the households by the investigators using a structured question-
naire and anthropometric parameters (weight, height, and brachial circumference) using
standard operating procedures. This methodical and rigorous process yielded detailed
and reliable information, essential for analyzing the profiles of children with and without
measles present in households in the district. A final check of the questionnaire was car-
ried out before leaving the household to complete any missing information. The consis-
tency of the data and any difficulties encountered were assessed at the end of each day.

2.7 Data processing and analysis

Once the field phase had been completed, the data were entered by the principal investi-
gator into Excel version 2013 and then imported into RStudio version 4.2.4 for analysis.
Microsoft Word and Excel 2013 were also used to generate figures and tables. The analy-
sis of this study took into account one dependent variable (measles status) and several
independent variables divided into 04 major groups (socio-demographic characteristics,
factors related to vaccination, factors related to the individual, and environmental fac-
tors). Descriptive statistics were calculated for all the variables taken into account. The
chi-square test was used to distribute the socio-demographic characteristics of partici-
pants according to their measles status. The association between dependent and inde-
pendent variables was determined by binary logistic regression, and all variables with a P
value < 0.05 in the bivariate analysis were candidates for multivariate analysis to control
for confounders and identify independent predictors of measles. The different indicators
were estimated with a significance level alpha (α) = 0.05 and only the variables with a risk
estimate (OR) associated with a P value less than 0.05 were significantly associated with
the increase in measles cases in the Logbaba health district.
Irita et al. Discover Public Health (2025) 22:376 Page 6 of 14

3 Results
During data collection, 327 participants were recruited. Of the 327 participants
recruited, 306 consented to take part in the study, giving a participation rate of 93.58%.

3.1 Description of participants’ characteristics based on measles status

Table 1 presents the distribution of sociodemographic characteristics according to
measles status in the Logbaba health district. Among the children studied, 15.69% of
measles cases were children under one year of age, compared to 7.35% among controls
(p = 0.044). With regard to the number of people in the household, 14.71% of cases lived
in households of 1 to 3 people, compared to only 4.90% among controls (p = 0.012).

Table 1 Distribution of participants socio-demographic characteristics based on measles status

Explanatory variables Measles status khi2 P-value
Case Controle [Df]
(n = 102) (n = 204)
Child’s age (in years)
< Under 1 year old 16 (15.69) 15 (7.35) 5.195 (2) 0.044*
1–2 years old 25 (24.51) 56 (24.45)
3–5 years old 61 (59.80) 133 (65.20)
Child’s sex
Female 58 (56.86) 131 (64.22) 1.261 (1) 0.261
Male 44 (43.14) 73 (35.78)
Number of people in your household
1–3 people 15 (14.71) 10 (4.90) 8.796 (2) 0.012 *
4–6 people 77 (75.49) 174 (85.29)
7 + people 10 (9.80) 20 (9.80)
Age of parent
< under 25 42 (41.18) 86 (42.16) 0.421
25–35 years old 55 (53.92) 100 (49.02) 1.729 (2)
36 + years old 5 (4.90) 18 (8.82)
Parent’s level of education
Primary 6 (5.88) 18 (8.82) 0.1379
Secondary 42 (41.18) 102 (50) 3.962 (2)
Higher 54 (52.94) 84 (41.18)
Parent’s religion
None 5 (4.90) 9 (4.41)
Christian 77 (75.49) 173 (84.80) 4.614 (2) 0.099
Muslim 20 (19.61) 22 (10.78)
Parent’s occupation
Student/Pupil 12 (11.76) 49 (24.02) 35.979 (4) < 0.001***
Unemployed 16 (15.69) 15 (7.35)
Informal sector 20 (19.61) 10 (4.90)
Private sector 29 (28.43) 101 (49.51)
Public sector 25 (24.51) 29 (14.22)
Marital status of the parent
Single 57 (55.88) 111 (54.41) 6.326 (3) 0.0967
Married 42 (41.18) 93 (45.59)
Separated/divorced 2 (1.96) 0
Widowed 1 (0.98) 0
Financial income per month
< 100 thousand 28 (27.45) 58 (28.43) 0.0518 (2) 0.974
100–300 thousand 50 (49.02) 100 (49.02)
hDon’t know 24 (23.53) 46 (22.55)
p-value: Significance Level; P < 0.001 ‘***;P < 0.01 ‘**’; P < 0.05 ‘*
Irita et al. Discover Public Health (2025) 22:376 Page 7 of 14

There was no significant difference in the sex of the child, with 56.86% of cases being
girls compared to 64.22% among controls (p = 0.261). The age of the parents, their level
of education, and their marital status were not significant, although the occupation
of the parents, particularly those who were students, was strongly associated with an
increased risk of measles (p < 0.001).

3.2 Factors associated with the recrudescence of measles cases in the Logbaba health
district
Table 2 presents the results of the analysis of socio-demographic factors associated with
the recrudescence of measles cases in the Logbaba health district. This table shows that
in bivariate analysis, age under 1 year [OR = 2.32 (95% CI 1.07–5.05); p = 0.031], living
in a household of 1 to 3 people [OR = 3 (95% CI 1.01–9.35); p = 0.040] and having par-
ents who are unemployed [OR = 4.35 (95% CI 1.71–11.49); p = 0.002] or who work in
the informal sector [OR = 8.16 (95% CI 3.13–22.84); p < 0.001] significantly increased
the recrudescence of measles cases in the Logbaba health district. However, the results
of multivariate analyses show that age under one year [AOR = 2.36 (95% CI 1.3–15);
p = 0.027], living in a household of 1 to 3 people [AOR = 7.28 (95% CI 1.12–71.44);
p = 0.001], and having unemployed parents [AOR = 24.66 (95% CI 3.13–278); p = 0.030]
were independent predictors of the resurgence of measles cases in the Logbaba health
district.
Table 3 presents the results of the analysis of factors related to vaccination status asso-
ciated with the recrudescence of measles cases in the Logbaba health district. The results
indicate that in bivariate analysis, non-compliant vaccination status, characterized by
the absence of vaccination [OR = 98.99 (95% CI 17.30-1892.12); p < 0.001], as well as non-
compliance with the vaccination schedule [OR = 56.88 (95% CI 17.36–104); p < 0.001],
were factors significantly associated with an upsurge in measles cases. In addition, the
absence of vaccine-related adverse events [OR = 3.58 (95% CI 1.19–15.48); p = 0.043] and
geographical proximity to a health facility within 30 min [OR = 4.25 (95% CI 1.29–19.32);
p = 0.030] also significantly increased the risk of measles infection in this locality. How-
ever, the results of multivariate analyses show that not having been vaccinated against
measles [AOR = 15.55 (95% CI 1.6–69); p = 0.037] or not following the vaccination sched-
ule [AOR = 13.49 (95% CI 1.44–38.82); p < 0.001] were independent predictors of the
resurgence of measles cases in the Logbaba health district.
Table 4 presents the results of the analysis of the environmental factors associated
with the recrudescence of measles cases in the Logbaba health district. This table shows
that in bivariate analysis, have been in contact with a measles patient [OR = 13.3 (95%
CI 3.02–36.03); p < 0.001], and regular visits to neighboring households [OR = 2.90 (95%
CI 1.59–5.56); p = 0.007], significantly increased the recrudescence of measles cases in
Logbaba health district. However, the results of multivariate analyses show that contact
with a measles patient [AOR = 9.08 (95% CI 1.44–53.3); p < 0.001] was the independent
predictor of the resurgence of measles cases in the Logbaba health district.
Table 5 presents the results of the analysis of personal factors associated with the
recrudescence of measles cases in the Logbaba health district. The table shows that in
bivariate analysis, lack of vitamin A supplementation [OR = 11.20 (95% CI 5.15–27.17);
p < 0.001], low level of knowledge about measles transmission routes [OR = 5.05 (95%
CI 2.24–13.58); p = 0.003], attending a facility where hand-washing facilities are absent
Irita et al. Discover Public Health (2025) 22:376 Page 8 of 14

Table 2 Socio-demographic factors associated with the recrudescence of measles cases in the
Logbaba health district
Explanatory variables Measles status OR P-value AOR P-value
Case Controle [CI 95%] [CI 95%]
(n = 102) (n = 204)
Child’s age (in years)
< Under 1 year old 16 (15.69) 15 (7.35) 2.32 [1.07–5.05] 0.031* 2.36 [1.3–15] 0.027*
1–2 years old 25 (24.51) 56 (24.45) 0.97 [0.55–1.69] 0.925 2.01 [0.63–6.27] 0.204
3–5 years old 61 (59.80) 133 (65.20) 1 1
Child’s sex
Female 58 (56.86) 131 (64.22) 1
Male 44 (43.14) 73 (35.78) 1.36 [0.83–2.21] 0.213
Number of people in your household
1–3 people 15 (14.71) 10 (4.90) 3[1.01–9.35] 0.040* 7.28 [1.12–71.44] 0.001**
4–6 people 77 (75.49) 174 (85.29) 0.88 [0.40–2.05] 0.766 0.47 [0.08–3.86] 0.883
7 + people 10 (9.80) 20 (9.80) 1 1
Age of parent
< under 25 42 (41.18) 86 (42.16) 1.75 [0.64–5.61] 0.295
25–35 years old 55 (53.92) 100 (49.02) 1.98 [0.74–6.25] 0.199
36 + years old 5 (4.90) 18 (8.82) 1
Parent’s level of education
Primary 6 (5.88) 18 (8.82) 1
Secondary 42 (41.18) 102 (50) 1.23 [0.48–3.60] 0.676
Higher 54 (52.94) 84 (41.18) 1.92 [0.75–5.59] 0.191
Parent’s religion
None 5 (4.90) 9 (4.41) 1
Christian 77 (75.49) 173 (84.80) 0.80 [0.26–2.67] 0.699
Muslim 20 (19.61) 22 (10.78) 1.63 [0.48–6.09] 0.440
Parent’s occupation
Student/Pupil 12 (11.76) 49 (24.02) 1 1
Unemployed 16 (15.69) 15 (7.35) 4.35 [1.71–11.49] 0.002** 24.66 [3.13–278] 0.030*
Informal sector 20 (19.61) 10 (4.90) 8.16 [3.13–22.84] < 0.001*** 32.71 [4.53–428] 0.170
Private sector 29 (28.43) 101 (49.51) 1.17 [0.56–2.56] 0.67 4.81 [0.87–41.49] 0.691
Public sector 25 (24.51) 29 (14.22) 1.52 [0.56–8.27] 0.102 2.63 [1.14–296] 0.241
Marital status of the parent
Single 57 (55.88) 111 (54.41) 1
Married 42 (41.18) 93 (45.59) 1.08[0.01–2.42] 0.603
Separated/divorced 2 (1.96) 0 0.7[0.001–1.22] 0.987
Widowed 1 (0.98) 0 0.07[0.003–1.14] 0.991
Financial income per month
< 100 thousand 28 (27.45) 58 (28.43) 1
100–300 thousand 50 (49.02) 100 (49.02) 1.03 [0.59–1.83] 0.90
Don’t know 24 (23.53) 46 (22.55) 1.08 [0.55–2.11] 0.819
AOR Adjusted Odds Ratio, OR Odds Ratio, CI Confidence Interval; p-value: Significance Level; P < 0.001 ‘***; P < 0.01 ‘**’;
P < 0.05 ‘*

[OR = 4.44 (95% CI 1.04–19.44); p = 0.041], and being undernourished [OR = 2.51 (95%
CI 1.48–4.27); p = 0.006] significantly increased the recrudescence of measles cases in
Logbaba health district. However, the results of multivariate analyses show that the
absence of vitamin A supplementation [AOR = 8.18 (95% CI 1.27-38); p = 0.002], attend-
ing a facility without handwashing facilities [AOR = 13.4 (95% CI 1.57–25.7); p = 0.017]
and malnutrition [AOR = 4.02 (95% CI 1.34–11.3); p = 0.0006] were independent predic-
tors of the resurgence of measles cases in the Logbaba health district.
Irita et al. Discover Public Health (2025) 22:376 Page 9 of 14

Table 3 Factors related to vaccination status associated with the recrudescence of measles cases in
Logbaba health district
Explanatory Measles status OR P-value AOR P-value
variables Case Control [CI 95%] [CI 95%]
(n = 102) (n = 204)
Knowing that your child needs to be vaccinated
No 1 (0.98) 1 (0.49) 2[0.07–51.17] 0.623
Yes 101 (99.02) 203 (99.51) 1
Child’s vaccination status
≥Two doses 1 (0.98) 15 (7.35) 1 1
One dose 35 (34.31) 179 (87.75) 2.93 [0.56–53.88] 0.305 4.1 [0.91-68] 0.117
Zero dose 66 (64.71) 10 (4.90) 98.99 [17.30- 18.12] < 0.001*** 15.55 [1.6–69] 0.037*
Vaccination schedule respected
No 75 (73.53) 1 (0.49) 56.88 [17.36–104] < 0.001*** 13.49 [1.44–38.82] < 0.001***
Yes 27 (26.47) 203 (99.51) 1 1
Need for vaccine
No 3 (2.94) 1 (0.49) 6.15 [0.77-125.22] 0.118
Yes 99 (97.06) 203 (99.51) 1
Has the mother been vaccinated?
Don’t know 25 (24.51) 19 (9.31) 3.18 [1.66–6.19] 0.33
No 1 (0.98) 1 (0,49) 2.42 [0.09–61.75] 0.534
Yes 76 (74.51) 184 (90.20) 1
Measles can be prevented by vaccination
No 1 (0.98) 0 1.22[0.72–2.38] 0.986
Yes 101 (99,02) 204 (100) 1
Adverse effects on children
No 99 (97.06) 184 (90.20) 3.58 [1.19–15.48] 0.043* 0.08 [0.001–0.41] 0.492
Yes 3 (2.94) 20 (9.80) 1 1
Remote vaccination site
No 97 (95.10) 189 (92.65) 1
Yes 5 (4.90) 15 (7.35) 0.64 [0.20–1.73] 0.417
Time to hospital
< 30 min 40 (39.22) 47 (23.04) 4.25 [1.29–19.32] 0.030* 24.5 [4.14–261] 0.397
30 to 60 min 59 (57.84) 142 (69.61) 2.07 [0.65–9.20] 8.66 [0.02–49.6] 0.383
> 60 min 3 (2.94) 15 (7.35) 1 1
Difficulties related to the vaccination service
No 97 (95.10) 176 (86.27) 1
Yes 5 (4.90) 28 (13.73) 0.32 [0.10–0.79] 0.424
AOR Adjusted Odds Ratio; OR Odds Ratio; CI Confidence Interval; p-value: Significance Level; P < 0.001 ‘***;P < 0.01 ‘**’;
P < 0.05 ‘*

4 Discussions
The main objective of this study was to investigate the factors associated with the recru-
descence of measles cases in the Logbaba health district. To do this, we assumed that the
increase in measles cases in the Logbaba health district would be linked to socio-demo-
graphic, vaccination-related, environmental, and personal factors. The results obtained
suggest interpretations which will be developed below in the light of other studies and
the scientific facts available to us.
This study showed that an age below 1 year was significantly associated with an
increase in measles cases in the Logbaba health district. This result differs from those
of studies carried out in the Woreda Artuma Fursi in Ethiopia [11] and Yemen [12],
where different age profiles were observed. This result may be explained by the fact that
young children, with their still-developing immune systems, are more likely to contract
Irita et al. Discover Public Health (2025) 22:376 Page 10 of 14

Table 4 Environmental factors associated with the recrudescence of measles cases in the Logbaba
health district
Explanatory variables Measles status OR P-value AOR P-value
Case Control [CI 95%] [CI 95%]
(n = 102) (n = 204)
Trip in the last 3 months
No 100 (98.04) 199 (97.55) 1
Yes 2 (1.96) 5 (2.45) 0.79 [0.11–3.76] 0.787
Contact with a measles patient
No 3 (2.94) 199 (97.55) 1 1
Yes 99 (97.06) 5 (2.45) 13.3[3.02–36.03] < 0.001*** 9.08 [1.44–53.3] < 0.001***
Number of cases of measles in the household
0 cases 1 (0.98) 204 (100) 1
1 case 101 (99.02) 0 1.22[0.57–2.28] 0.995
Measles cases in neighboring household
No 101 (99.02) 199 (97.55) 1
Yes 1 (0.98) 5 (2.45) 0.39 [0.02–2.48] 0.398
House ventilated/ventilated
No 20 (19.61) 41 (20.10) 1
Yes 82 (80.39) 163 (79.90) 0.96 [0.52–1.74] 0.919
Number of people per room
1–2 people 34 (33.33) 84 (41.18) 1
3–4 persons 68 (66.67) 120 (58.82) 1.40 [0.85–2.31] 0.185
Walks in neighboring households
No 15 (14.71) 68 (33.33) 1 1
Yes 87 (85.29) 136 (66.67) 2.90 [1.59–5.56] 0.007*** 2.13 [0.18–22.3] 0.519
AOR Adjusted Odds Ratio; OR Odds Ratio; CI Confidence Interval; p-value: Significance Level; P < 0.001 ‘***;P < 0.01 ‘**’;
P < 0.05 ‘*

infections, particularly when vaccination coverage is inadequate. This underlines the

crucial importance of effective and accessible vaccination programs to protect this age
group. In addition, it is necessary to take into account contextual factors such as access
to healthcare, cultural beliefs about vaccination, and socioeconomic conditions, which
can influence the spread of the disease and families’ response to prevention.
In addition, residence in a household of 1 to 3 people was significantly associated
with an increase in measles cases in the Logbaba health district. This result is similar
to that of a study conducted in Cameroon [13] and may be explained by the fact that
small households may have more intense social interactions, thus increasing the risk of
transmission of the virus, especially if family members are not vaccinated. In addition,
these households may have limited access to healthcare resources, which complicates
the prevention and treatment of infections. It is also possible that in smaller households,
children are less exposed to protective environments, such as extended family networks
that could offer a degree of herd immunity.
In addition, we found that having unemployed parents was also a major predictor of
increased measles cases in the Logbaba health district. This finding is consistent with
that of a study conducted in Cameroon [14] and may be explained by the fact that unem-
ployed families often have limited financial resources, which may restrict their access
to healthcare, including essential vaccinations. In addition, the economic stress associ-
ated with unemployment can lead to neglect of preventive care, with parents more pre-
occupied with immediate survival needs. This lack of awareness and access to health
Irita et al. Discover Public Health (2025) 22:376 Page 11 of 14

Table 5 Analysis of personal factors associated with measles recrudescence in Logbaba district,
classified by nutrition, knowledge, and hygiene
Explanatory variables Measles status OR P-value AOR P-value
Case Control [CI 95%] [CI 95%]
(n = 102) (n = 204)
Vitamin A supplementation
No 32 (31.37) 8 (3.92) 11.20 [5.15–27.17] < 0.001*** 8.18 [1.27-38] 0.002**
Yes 70 (68.63) 196 (96.08) 1 1
Chronic illness
No 100 (98.04) 203 (99.51) 1
Yes 2 (1.96) 1 (0.49) 4.06 [0.38–87.97] 0.255
Knowledge of transmission routes
No 96 (94.12) 155 (75.98) 5.05 [2.24–13.58] 0.003** 2.06 [0.51–3.9] 0.708
Yes 6 (5.88) 49 (24.02) 1 1
Regularly suffering from an infectious disease.
No 99 (97.06) 199 (97.55) 1
Yes 3 (2.94) 5 (2.45) 1.20 [0.24–5.01] 0.8
Washing hands regularly
No 6 (5.88) 5 (2.45) 2.48 [0.73–8.82] 0.14
Yes 96 (94.12) 199 (97.55) 1
Hand-washing facilities in the establishment
Don’t know 9 (8.82) 40 (19.61) 1 1
No 5 (4.90) 5 (2.45) 4.44 [1.04–19.44] 0.041* 13.4 [1.57–25.7] 0.004**
Yes 88 (86.27) 159 (77.94) 2.45 [1.18–5.62] 0.221 1.42 [0.56–19.9] 0.114
BMI status
Undernutrition 40 (39.22) 40 (19.61) 2.51 [1.48–4.27] 0.006*** 4.02 [1.34–11.3] 0.017*
Normal 62 (60.78) 156 (76.47) 1 1
Overweight 0 8 (3.92)
BMI Body Mass Index; AOR Adjusted Odds Ratio; OR Odds Ratio; CI Confidence Interval; p-value: Significance Level; p < 0.001
‘***; P < 0.01 “**”; P < 0.05 “*”.

services can lead to insufficient vaccination coverage, increasing children’s vulnerability

to infection.
Not having been vaccinated against measles was significantly associated with an
increase in measles cases in the Logbaba health district. This finding is consistent with
studies conducted in Mongolia [15], Ethiopia [3], Guinea [16], and Pakistan [17], and
may be explained by the fact that unvaccinated individuals, particularly young children,
are particularly vulnerable to this highly contagious disease, which facilitates its spread
within the community. In the absence of vaccination, children exposed to the virus can
rapidly develop symptoms and transmit the disease to others, increasing the number of
cases. In addition, low vaccination rates compromise herd immunity, which is essential
to protect people who cannot be vaccinated for medical reasons.
Non-compliance with the vaccination schedule significantly increased the incidence
of measles in the Logbaba health district. This finding is similar to that of a study con-
ducted in the United States [18] and can be explained by the fact that when children
do not receive their vaccinations on time, they remain vulnerable to infection, which
facilitates the spread of the virus within the community. This situation is exacerbated by
the fact that measles is highly contagious, being easily transmitted by air. What’s more,
a well-adhered vaccination schedule helps maintain sufficient vaccination coverage to
achieve herd immunity, protecting not only those who have been vaccinated but also
those who cannot be vaccinated for medical reasons. Consequently, non-compliance
Irita et al. Discover Public Health (2025) 22:376 Page 12 of 14

with vaccinations creates pockets of susceptibility that encourage measles epidemics and
jeopardize public health.
The absence of vitamin A supplementation and a history of contact with a measles
patient was significantly associated with an increase in measles cases in the Logbaba
health district. This result is in line with those of studies conducted in Ethiopia [3],
Guinea Conakry [16, 19], and Pakistan [17], and can be explained by the fact that mea-
sles spreads easily by air, through respiratory droplets emitted when an infected person
coughs or sneezes, and can also be transmitted by direct contact with contaminated sur-
faces. As a result, individuals who have been in contact with a measles patient run an
increased risk of infection, especially if they have not been vaccinated or have not devel-
oped prior immunity.
The recrudescence of measles cases in the Logbaba health district may be explained
by factors such as the lack of vitamin A supplementation, as observed in our study. This
result is similar to those of studies carried out in Bamako [20, 21], where participants
who had not received vitamin A had a higher risk of measles and can be explained by the
fact that vitamin A is essential for maintaining the integrity of mucous membranes and
the optimal functioning of immune cells, which helps fight infections, including mea-
sles. Vitamin A deficiency can make individuals more susceptible to complications from
measles, increasing the severity of the disease and the risk of transmission. In addition,
vitamin A supplementation is recommended to reduce the mortality and complications
associated with measles, particularly in young children. Consequently, the absence of
this supplementation contributes not only to an increase in measles cases but also to a
worsening of clinical outcomes in the vulnerable population.
However, attending a facility that lacked proper hand-washing infrastructure was sig-
nificantly associated with a higher incidence of measles cases in the Logbaba health dis-
trict. This result can be explained by the fact that hand washing is a fundamental public
health measure that reduces the transmission of pathogens, including the measles virus,
which can be spread by direct or indirect contact. In environments where hand-wash-
ing facilities are inadequate, individuals are more likely to spread the virus, especially in
places frequented by unvaccinated or vulnerable children.
Undernutrition was also a major predictor of the recrudescence of measles cases in
the Logbaba health district. This result is in line with those of studies carried out in
Madagascar [22], Côte d’Ivoire, and Yemen [12] and can be explained by the fact that
malnourished children generally have an altered immune response, which can lead to a
more serious progression of the disease and an increase in complications. In addition,
undernutrition can reduce the effectiveness of vaccines, thereby diminishing the pro-
tection conferred by vaccination. Undernutrition is, therefore, a key risk factor that not
only favors measles transmission but also exacerbates the clinical consequences of this
infection, jeopardizing the health of the most vulnerable populations.

4.1 Limits of the study

This study has several important limitations. First, the case-control design does not
meet the temporal criterion necessary to establish a causal relationship, which compli-
cates the determination of the order of appearance of exposure factors in relation to the
onset of measles. In addition, this type of design may introduce selection bias if the par-
ticipants are not representative of the general population of the Logbaba health district.
Irita et al. Discover Public Health (2025) 22:376 Page 13 of 14

Data collection through questionnaires administered to parents may also be subject to

recall or interpretation bias, which could affect the accuracy of the responses obtained.
Although we evaluated many variables, a risk of residual confounding remains, as some
unaccounted variables may be associated with the results. Finally, although the sample
size is significant, this may limit the generalizability of the results to other contexts. It
is therefore crucial to conduct further studies to validate these results and explore the
dynamics of measles transmission in greater depth. A better understanding of these
aspects will enable public health strategies to be targeted more effectively.

5 Conclusion
This study identified several factors associated with the resurgence of measles cases in
the Logbaba health district, including the age of children under one year old, which is
often linked to inadequate vaccination status due to ineligibility or delays in vaccina-
tion. Other factors, such as small family size, parents’ employment status, and adherence
to the vaccination schedule, were also noted as important contributors. Other predic-
tive factors included lack of vitamin A supplementation, lack of handwashing facilities,
malnutrition, and previous contact with measles patients. To address these findings, it
is essential that health authorities strengthen protection for children under one year of
age by maximizing vaccination opportunities as soon as they become eligible, including
through vaccination campaigns and awareness-raising during prenatal consultations. In
addition, increasing vaccination coverage beyond the herd immunity threshold can help
protect siblings attending school, as well as those who are not yet eligible for vaccina-
tion. A better understanding of these factors can help optimize the allocation of public
health resources and support efforts to reduce the incidence of measles in Cameroon.
Continued research and the implementation of effective strategies are needed to protect
vulnerable populations and reduce the morbidity and mortality associated with this pre-
ventable disease.
Acknowledgements
We would like to express our deep gratitude to all the individuals and institutions that contributed to the realization of
this study. In particular, we thank the Institutional Ethics Committee for Human Health Research of the School of Health
Sciences of the Catholic University of Central Africa for its approval and support. Our thanks also go to the health staff
of Logbaba district for their valuable collaboration in data collection. We are grateful to the parents and guardians who
agreed to participate in this study, and to the investigators for their commitment. Finally, many thanks to our families and
friends for their moral support and encouragement during this research.
Author contributions
Author contributions: F.I. designed the study and supervised the overall project. G.R.P.D. contributed to the methodology
and data analysis. K.C.F.T. participated in data collection and drafting of the manuscript. J.R.M.T. helped analyze the
results and revise the text. A.S.M.M. contributed to data collection and preparation of necessary documents. P.D.N.T.
was involved in interpreting results and writing. G.K.T. helped with editing and final formatting of the manuscript. M.A.Y.
supervised the ethical and administrative aspects of the study. VDZ contributed to the literature review and provided
critical perspectives on study design.
Funding
The authors declare that no funding was received for the conduct of this research or for the preparation of this article.
The study was carried out without external financial support.
Data availability
All data used and/or analyzed for this study are available from the corresponding author upon reasonable request.

Declarations
Ethics approval and consent to participate
Before starting this study, we obtained the necessary authorizations from the scientific research committee of the École
des Sciences de la Santé (N°2020/020151/CEIRSH/ESS/MSP) and from the Délégué régional de la santé publique du
Littoral (N°0274/AAR/MISANTE/DRSPL/BCASS). All participants provided written informed consent, with an assent form
available for signature. Detailed explanations were provided to emphasize the importance of the study, without financial
Irita et al. Discover Public Health (2025) 22:376 Page 14 of 14

compensation. Measures were put in place to guarantee confidentiality and respect for participants’ autonomy. Finally,
awareness-raising on measles prevention measures was offered at the end of the interviews.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.

Received: 16 February 2025 / Accepted: 24 June 2025

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